Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment

Abstract

Aim: To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis.Methods: This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM-No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable.Results: Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed.Conclusions: Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

Earlier detection of gestational diabetes impacts on medication requirements, neonatal and maternal outcomes

“…27 This is why in specific high-risk populations, initiating the diagnostic process in the first trimester or at the patient's initial prenatal appointment is advisable to discard pre-existing diabetes and to identify early-onset (before the 24th week of pregnancy) diabetes (eGD), whose detection precedes the conventional diagnostic window. 5,28,29 This 'early-onset' variant, manifesting before the standard diagnostic timeframe, 30,31 holds significance because of its potential impact on critical foetal development during the second trimester. 27,32,33 The objective of this study was to investigate the impact of GD diagnosis timing on maternal, foetal and neonatal outcomes, comparing outcomes between eGD (diagnosed before the 24th week of gestation) and GD diagnosed within the conventional diagnostic window (24-28 weeks of gestation).…”

“…This is why in specific high‐risk populations, initiating the diagnostic process in the first trimester or at the patient's initial prenatal appointment is advisable to discard pre‐existing diabetes and to identify early‐onset (before the 24th week of pregnancy) diabetes (eGD), whose detection precedes the conventional diagnostic window 5,28,29 . This ‘early‐onset’ variant, manifesting before the standard diagnostic timeframe, 30,31 holds significance because of its potential impact on critical foetal development during the second trimester 27,32,33 …”

Despite treatment, HbA1c &gt; 37mmol/mol in the first trimester is associated with premature delivery among South Asian women with gestational diabetes mellitus: a retrospective cohort study

“…Additionally, GDM identi ed in the rst trimester is associated with much more adverse events than observed among women with 'standard' GDM diagnosed after 24 GW [27,28]. In the iconic 2020 Norbert Frienkel lecture, David Simmons denoted early onset GDM as 'Prevalent GDM' indicating it as preexisting glucose intolerance, discovered in early pregnancy [29].…”

“…Even though not validated for use before 24 gestational weeks (GW), the oral glucose tolerance test (OGTT) is often used in South Asia to diagnose GDM in early pregnancy [22,23]. This strategy identi ed early-onset 'hyperglycemia' in 15-70% of GDM women of South Asian ethnicity, and such hyperglycemia was associated with a signi cantly increased risk for adverse pregnancy outcomes [24,25,26,27].…”

Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

“…The criteria used to classify glucose tolerance in pregnancy show some differences (18). In studies, these women's metabolic state are referred to impaired glucose tolerance (IGT), insulin resistance, carbonhydrate intolerance, gestational impaired glucose tolerance (G-IGT) and borderline gestational glucose intolerance (BGGI ) (18)(19)(20)(21)(22)(23)(24)(25).…”